Insurance & Financing

Hello, I have BCBS- Ohio. The requirements state documentation of 6 months non-surgical attempts at weight loss. When speaking to a BCBS nurse the other day, she stated that the consistent documentation I've done of my weight loss journey on Instagram should count with doctors approval. This goes back 18 months and includes pictures of the scale, food and exercise posts. However after reading the following, I'm wondering if I'd still have to go through the formal 6 months. Thoughts? Sent from my iPhone using the BariatricPal App

Anyone out there have state Medicaid and in the fast track for surgery due to medical necessity? I have pseudotumor cerebri and am wondering if anyone has ever gotten approved in three months? My dr said that's the fastest track Sent from my iPhone using the BariatricPal App

I'm in my 5th month of the supervised diet - all preop stuff done- just waiting for time to pass and was informed today (by chance!!) that Triwest will not cover the sleeve. I am in shock. I called Tricare and they confirmed this, but said maybe a different code would work? The CPT code given by my doctors office is 43775. Has this happened to anyone else? I live in Alaska so going down to the lower 48 would be a challenge. And costly.

Does anyone know of any Beriatric doctor's in Houston that take patients on Medicade? Sent from my SM-G920P using the BariatricPal App

Hey there! I have been scoping out these forms for quite some time now! I have been researching for a few months making sure this is something I want to do... and it is. Not for vanity reasons (but lets be real... nice perk), but because I don't want diabetes, I don't want to hurt every time I walk, I want to be able to breathe like a normal person, I don't want high blood pressure... the list goes on and on. I just moved to SoCal for employment reasons and my insurance with Kaiser doesn't kick in until Feb 1st. Does anyone know if I have to be a Kaiser member for x amount of time before I can even start the process? My insurance does cover it per the paperwork I filled o…

Hello! Anyone have this insurance? I just completed all of my requirements to submit to insurance and I'm hardly a patient person. How long did the approval or denial take? Sent from my iPhone using the BariatricPal App

Has anyone gotten approved or been told that anthem blue cross blue shield will cover any kind of surgery in CT. I have anthem through the state because I am part time and I keep getting conflicting stories. I have my first consult with my surgeon February 17th and it is an anthem blue distinction center plus so I feel like they should cover part of the surgery, but because I have state insurance I don't think they do. I hear good things about bcbs in other states, but CT doesn't require insurance companies to offer weight loss surgery. My backup plan is Mexico but I'd much rather just have surgery on my own state. I'm going to a Saint Francis hospital in Hartford. Than…

I am sure this has been talked about at one time or another but, here goes.... Does anyone know if FEPBCBS covers the removal of skin after surgery? If so talk to me about the process and what is needed.

How long did it take to get approved? Sent from my SM-N910V using the BariatricPal App

I about had a heart attack this morning when I finally got the bill for my surgery. A bill for 18k. For about 15 minutes I was frantic, because I had all kinds of insurance problems with my surgery; apparently the doctor was covered, but the hospital wasn't. They managed to work out a deal where the hospital got paid at the in-network rate and I would only have to pay copay + remaining deductible. Then, something clicked in my head. Copay + remaining deductible -- I should have owed 1800. Of all the bullshit I went through to get my insurance to cover my surgery, I could think of nothing but the fact that something had gone wrong and I was being held responsible f…

Anyone in Washington state going through Molina? I was just approved but they said it takes a year? Once a month visits to dietitian and pt for 12 months. Seems like a long time Sent from my iPhone using the BariatricPal App

Hi all, So I have a tentative surgery date of 11/11! My first visit w/ my wlc, my BMI was 41.2 (something like that). I met with the surgeon on Tuesday and my BMI was 39.8 (no comorbids). He's going to submit my paperwork and they are using the first weight. I asked if I might get denied by my insurance because the BMI went down. And he said "it depends, I'm wording my note a certain way and I don't think it'll be a problem". He didn't even feel the need to order a sleep apnea test, which I have no idea if I have or not. He said I have "the best" insurance in terms of requirements, etc, whatever that means. He was very nice, almost TOO chill for a surgeon... So at th…

I have amerihealth NJ through my employer and i have been trying for weeks to get their requirements. Is anyone on the forum a participant of Amerihealth? I have a BMI of 36.7 and I have high blood pressure and high cholesterol. I meet with my doctor for the first time next week and i am frightened i will be turned away or told i need to gain 40 more pounds.... as if i want to gain more weight!!!.. Anyone with experience?

I was sleeved on 12/22. I have GEHA Insurance which is Federal insurance. I jumped through hoops and did everything I needed to do for this surgery. I got my pre approval letter in before my surgery. I had the surgery done and here I am thinking how wonderful my insurance is! I get a letter in the mail today from Conifer Health Solutions stating that GEHA transferred my $54,000 claim to them last minute and they decided to DENY MY CLAIM!!! This is all I need after a major surgery. Please if anyone is going through something like this please help me! I am having to look at bankruptcy because this costs half my house!! Sent from my SM-G930V using the BariatricPal App

So I got the call today that my insurance approved my surgery!! Yes! On to my question, I am a smoker and my surgeon requires his patients to be 60 day nicotine free before he'll perform any procedure. Fine, no big deal. I should already have been quitting to anticipate the procedure. My question is how long do surgical approvals last? I'm courting the idea of February for my sleeve but I'm curious as to whether I'll have to seek another approval or if once it's approved I can do it whenever?! The insurance company and plan will not be changing in 2017. Any advice is appreciated! Sent from my SAMSUNG-SM-N910A using the BariatricPal App

I was wondering if anyone has any insurance to cover them in case of complications post bariatric surgery? I am self pay, have regular health insurance, but it does not cover WLS. I also have supplimental Hospital Indemnity insurance. However, if I have complications from VSG, I want to make sure I am covered. Sent from my SM-G920V using the BariatricPal App

I called my insurance and it is officially approved! Now I will wait to see when they can schedule me and start my preop diet. This seems surreal!! Sent from my iPhone using the BariatricPal App

I am a self pay. I want to get insurance in case of complications. Has anybody used it or can recommend one? Sent from my SM-G920V using the BariatricPal App

Someone please tell me it will all be worth it? My surgery is scheduled for Feb 1st. I'm excited even though a few are against it. I.e.: co-workers who either weigh 100 lbs wet or who are 100 or more lbs overweight themselves. I will admit at 5'5 and 246lbs I do hide my weight well but the countless other health issues behind it, I don't care what I look like! I care how I feel! But learning that my $2500 insurance deductible with BCBS of MI rolls over in January not August anymore and I am already $900 out of pocket, and to my knowledge about $1000 out of budget on what I had set aside for surgery... the only thing that's losing weight is my bank account! I m…

Hi there, I spoke to my insurance and I feel like I knew all of the qualifications except for being smoke-free for 6 months prior to the surgery, I have BCBS FEP, I can quit today, I really only smoke in the evening with my husband so the smell of him smoking doesn't bother me. Prior to that it was a serious contention in our marriage. We'll figure out what we'll do... but how do I prove that I quit? Do I need to join smoking cessation program? The doctors office knows I have about 1 cigarette a day. Sent from my iPhone using the BariatricPal App

Just sharing my approval with Highmark BCBS of PA, I was approved within 3 days and received a letter by the weekend. I'm ecstatic, but my parents who aren't very supportive of the surgery are unhappy. It sucks because I want to share my joy and happiness, but they're being happiness sponges. Any advice on what I can say to try and remedy the situation? My possible surgery date is January 17th- and I've decided on gastric bypass. Sent from my iPhone using the BariatricPal App

Received my explanation of benefits from my surgery, and it was over $43,000!! 100% covered by insurance, and they actually didn't even discount it, they paid what the hospital was asking. Unbelievable.

Does anybody here have the Ms State Employee Insurance? I am looking at the policy documents and I feel a little bit like I am reading the tax code. Is there a clear cute plan of action that anyone has followed to get approved? Sent from my iPad using the BariatricPal App

Hello, I'm new to the board and I'm very interested in having vsg surgery here in Louisville, KY. I've been to the seminar at Baptist East with Dr. Oldham and I'm waiting for them to call to set up my first appt. I have insurance, but it has a $10,000 lifetime maximum, so it may be a better option for me to self pay. Does anyone been given any estimates for self pay rates in Louisville, particularly at Baptist East? Sent from my iPhone using the BariatricPal App

I have surgery on the 21st and can't get clear numbers on how much I'll have to pay and when. I know I pay 15% of the plan, plus $350 for the hospital stay. I've met my deductible. How much did you have to pay before surgery with BCBS FED? Thx. Sent from my iPhone using the BariatricPal App

I have Wellcare (Medicaid) of Georgia, I had to complete the 6 month supervised WLS visits, after completing anybody know how long before approval after submission? Then the process after approval?

Hi im from MN im wondering if anyone on here has health partners for insurance and if they have helped cover your weight loss surgery! Sent from my SM-G935V using the BariatricPal App

Hi all, As I'm reading posts, I realize that some insurance requires a BMI 40+ for 2+years. I didn't see that on the highmark policy explicitly. I don't have diagnosed comorbidities, and I was somewhere between 35-40bmi two years ago. (I have pcos, but I don't think that counts.) Has anyone else with highmark been denied for their BMI history being too low? Thanks! Sent from my SM-G900T using the BariatricPal App

Anyone have Dr Fitzer from Virginia Bariatric Surgery Center? What were his requirements for you? Sent from my iPhone using the BariatricPal App

So I started the process today, met with intake. They had me call the Finance Counselors. I had already used the estimator on KP.org, so I was expecting 4 to 5k out of pocket. The counselor says no, it's 14k. They break it up into 36 payments of 338, which is after paying 2k just to schedule the surgery. Is that normal? I mean that's a car payment...I was okay with this when the estimator said the 4-5k. I'm not so sure I can put this financial burden on my family, even for the sake of my health. Is anyone aware of options I can look into? I'm in Colorado if that makes a difference.

Does anyone know if the first consultation will count as my first weight in? I have aetna and was told that one doesn't count by a nurse. However that was really the 1st appointment. I weighed 250 at that one. The next appointment I was 246. My last appointment I was 247. I am afraid of not getting approved because I don't know which one they will count as my 1st appointment and they specifically say onr their site that you have to weigh the same or less on your last appointment.

Hey! So it's the beginning of the year and of course my insurance has changed. Unsure if anything is covered at this point , I have 2 visits left with the dietician. Any of you guys have any issues with insurance? How did you handle things? I've tried talking to my bf about it, but he doesn't seemed to concerned or care ha

I had my surgery on 10/26 and boy, the medical bills are steadily coming in! I have to say how thankful I am that this was covered by my insurance! The hospital stay for two days was over 35k alone! I'm very thankful...and I truly sympathize for the self-pay folks! I understand how important this surgery is to some...and they will do whatever they need to do to get it! have a good evening!! Sent from my SAMSUNG-SM-G930A using the BariatricPal App

Hello! Has anyone self-paid for a sleeve in Phoenix or Tucson (not looking to go to Mexico even though AZ is so close to the border)? If so what was the total cost, who was your surgeon, the office name, and the hospital where the surgery took place? Thanks!

I'm from Iowa. I have healthcare through the school (I teach) and it's a small mom/pop kind of health insurance. My surgery center says they've only have 2 other people with this insurance come through and they were both approved within 1 day. My insurance only requires 3 things, 100 pounds overweight, 2 doctor letters and pre-authorization. I'm a little nervous about being approved though. I'm much overweight (my BMI is 57), but I do not have sleep apnea, diabetes, or high blood pressure (surprisingly). I do have back pain, and some joint pain when exercising/moving. Can insurance deny me, just because I'm overweight, and have no other heath problems?

Anyone have this? What were their requirments? Sent from my iPhone using the BariatricPal App

I prefer my sleeve surgery to be done in in America. Is there a Dr. Anywhere who does it as a cash pay for close to Mexico price? Sent from my SAMSUNG-SM-N920A using the BariatricPal App

Hi everyone! Just had my consult with my surgeon today. I have my first nutritionist appt on 2/12. Dr said that I should go to him to be weighed before each nut. visit. I also have to get the psychologist appt in as well. For those who have my plan, did the insurance cover the Nut visit and psych visit? Also what other hoops do I have to jump through to get approved? My BMI is 41 and don't have any comorbidities (thankfully, although would help for insurance approval)

My lady has cigna and its a 10% surgery copay am I billed after or befor her surgery. Sent from my SM-G930V using the BariatricPal App

So I got the call today that my insurance approved my surgery!! Yes! On to my question, I am a smoker and my surgeon requires his patients to be 60 day nicotine free before he'll perform any procedure. Fine, no big deal. I should have already quit to anticipate the procedure. My question is how long do surgical approvals last? I'm courting the idea of February for my sleeve but I'm curious as to whether I'll have to seek another approval or if once it's approved I can do it whenever?! The insurance company and plan will not be changing in 2017. Any advice is appreciated!

In 24 hours, I was just approved by my insurance company for my surgery. I have UnitedHealthcare through the state of MD. I'm a state employee. OMG! This is really happening. Surgery Date January 31st. Loving Me

Anyone else have this? Sent from my iPhone using the BariatricPal App

My dr submitted my package to aetna and im super nervous they will deny me. Ive been through this since july and im really eager to get the vertical sleeve & start a new life. Im 25 with a bmi of 49. Does anybody have aetna and what did you experience with them Sent from my SM-G935V using the BariatricPal App

I posted on this topic a couple of days ago. Apologies for the duplicative post if you've already read it. So, I have BCBS of IL but currently reside in Virginia. My surgeons office told me that insurance requires 6 month MSWL. I spoke with BCBS of IL (twice) and they assured me that there is no 6 month MSWL requirement. I then spoke to the surgeons office again and told them what insurance told me and the response was "we have to follow the BCBS of Virginia guidelines". Ummm...what?! Why?! It makes no sense to me. I don't have BCBS of VA! Has anyone had a similar experience? I'm so annoyed with these people. Why would I have to follow VA guidelines when my insurance…

Does anyone who has BCBS received a Summary of Health Plan Payments after surgery? I received a few. One for the surgery itself, and two others for like, pathology and radiology services. These aren't bills, but it breaks down the cost of the services, how much BCBS is paying, and how much I'll owe. It actually says "your healthcare provider will bill you this amount" at the bottom. When can I expect the actual bill to come? I was sleeved on 11/11. It's great that they are giving me a heads-up I guess, but I'd rather just get the bill and be done with it.

So had my first appointment at the surgeon's office today where they went over the requirements needed for the insurance company. I knew my plan didn't make me complete the 6 month deal. My BMI is at 37 but I have high blood pressure/cholesterol. I figured I might have had a shot until the paperwork specified I had to be diagnosed with these conditions for the 3 previous years also. And have only been officially diagnosed for a year. I have the local government plan, anybody have any insight? At this point, I'm kinda just really disappointed I guess. Thanks for any opinions. Sent from my iPhone using the BariatricPal App

Any insurance companies that don't have the 3 or 6 month diet and exercise program? Sent from my iPhone using the BariatricPal App

So can anyone please tell me what their experience with the approval process; how long, I've been waiting since 12/6! This waiting is the worst!! Sent from my SM-G930T using the BariatricPal App

I have thought about the approval process for my gastric sleeve about 100 times. I have really just started the process. I went to my first seminar and I am starting to do my supervised diet visits. I don't have documented sleep apnea but I am going to have them check for it. I have hypertension (lower BP # is 98 or higher). The surgeon put me on a BP RX but I don't think it's the one aetna will approve for because it's not a 3 drugs in one. I am so scared I am wasting my time because I won't get approved.... Is anyone in a similar boat that could offer some advice? Thanks in advance

So was there any out of pocket cost for those folks having BCBS of Illinois? Sent from my SM-G930T using the BariatricPal App